Overview

Children usually move in natural, predictable steps as they grow and develop language, cognitive, social, and sensory and motor skills. But each child gains skills at their own pace. It's common for a child to be ahead in one area, such as language, but a little behind in another.

At routine checkups, your child's doctor will check for milestones. This is to make sure that your child is growing and developing as they should. Your doctor can help you know what milestones to watch for as your child gets older. Or you can look for sources of information and support nearby. Public health clinics, parent groups, and child development programs may help. Knowing what to expect can help you spot problems early. And it can help you feel better about how your child is doing.

Talk with your doctor about any concerns you have about your child's health, growth, or behaviour. Do this even if you aren't sure what worries you.

Your relationship with your child will change as your child gains new skills and develops independence. As your child's world gets bigger, you can help your child grow in healthy ways. Here are a few things you can do. Spend time together. Be a good role model. Show your child love and affection.

What to Expect

Your child's rapid brain development between the ages of 12 and 24 months causes amazing changes to happen—such as talking, walking, and remembering—as your child enters the toddler years. Children usually progress in a natural, predictable sequence from one developmental milestone to the next.

The changes that happen in this period are often grouped into five areas:

Physical growth.

Although slower than in the first year of life, physical growth continues at a steady pace. Expect your child to grow about 7.6 cm (3 in.) to 12.7 cm (5 in.) and gain about 1.4 kg (3 lb) to 2.3 kg (5 lb). Teething continues with the eruption of the first molar teeth.

Cognitive development.

This is your child's ability to think, learn, and remember. Your child will start to remember recent events and actions, understand symbols, imitate, imagine, and pretend.

Emotional and social development.

Toddlers form strong emotional attachments. They often feel uneasy when they are separated from their loved ones. Your child may feel uneasy and cry when separated from you. During this time, toddlers often develop two conflicting feelings: wanting both independence and reassurance from their parents. Around the same time, they often want to do things on their own or according to their own wishes. This sets the stage for conflict, confusion, and occasional breakdowns. Toddlers' emotions change often. But their personalities and temperament are becoming more defined.

Language development.

At 12 months, many children can say a few words. And they jabber often. At 15 to 18 months, a typical toddler understands 10 times more than they can put into words. Speech begins with one- or two-syllable words, such as "mama." This progresses to short two-word sentences, such as "no peas" or "walk dog," sometime between 18 and 24 months. By 24 months, most toddlers can say at least 50 words.

Sensory and motor development.

Motor skills develop as your child's muscles and nerves work together. Toddlers gain control and coordination and become steady walkers. Climbing, running, and jumping soon follow.

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Common Concerns

Keeping track of your fast-moving 12- to 24-month-old child can be a challenge. Also, your child who was loving and well-mannered may suddenly start having "meltdowns" without warning. It's normal to be both excited and worried about your child's new mobility and unpredictable behaviour.

During ages 12 to 24 months, your toddler may:

Rarely mind and may frustrate you.

It's normal for toddlers to ignore you or protest when you ask them to do (or not do) something. Their resistance to your directions are expressions of the inner struggles they have while trying to become more independent. Toddlers don't understand when you try to reason with them. Try giving your child clues ahead of time about what you want and what is going to happen. For example, if you are going to leave grandma's house soon, start waving "bye-bye" to people and toys about 10 minutes before you go. Explain that you are going soon. Repeat the waving every few minutes. This gives your toddler time to adjust to the idea of leaving.

Have temper tantrums.

During this second year, toddlers start to understand that they are individuals—a unique and separate person from their parents and everyone else. This awareness brings up many new issues, especially related to strong emotions and confusion about what they can and can't control. A toddler wants to be the master of his or her universe. Toddlers become easily frustrated when they can't do things they want to do. They may say some words and a few phrases. But they can't express themselves fully. This sets the stage for angry outbursts that can surprise and confuse parents. Don't take it personally when your child has a temper tantrum. This behaviour is normal. Try using methods to prevent temper tantrums, such as distracting your child, rather than just saying "no." (Realize, though, that sometimes nothing will work.) After a tantrum is in full swing, it may help to ignore it. Stay close, be supportive, and talk calmly.

Be a picky eater.

Often, being picky about food happens because your child wants to assert his or her independence. Your child may also sometimes simply not be hungry. Eating patterns can change suddenly. Toddlers may eat well for a day or two, then eat very little for the next few days. As long as you adopt healthy eating strategies, such as by offering healthy foods and snacks, your child's unpredictable eating habits will likely not be a problem.

Nap less.

Usually by around 18 months of age, sleeping patterns change and toddlers may try to abandon the morning nap. As a result, your child may have tired, cranky periods. Try to fit in an afternoon nap. Your child still needs rest. Adjust to changing nap patterns by planning quiet times to regroup. Also, stick to a nighttime routine with a regular bedtime. For example, give your child a bath, put on pyjamas, and read books in the same order each night.

Make messes.

Many toddlers find it great fun to open drawers and cupboards-and love even more to remove every item they find. Be careful what you store in your bedside table and other cupboards that are lower than your shoulder height. Many toddlers also like to "sweep" all the contents off any shelves they can. It may help to give your child his or her own cupboard or shelf to play with. Place soft toys on a shelf or plastic bowls, lids, and containers in a cupboard. Your child can then play freely and feel in control.

Seek out danger.

Your child may seem drawn to stairs, electrical outlets, and breakable objects. After your child is up and moving around, it is important to provide safe ways to explore. Try to keep items that could cause choking out of reach.

Show separation protest.

Also called separation anxiety, this is an uneasiness or fear your child feels when you or another caregiver leaves. Most children's separation-protest phase peaks around 10 months of age. But in some children it lasts longer or happens again. Your child's temperament as well as your own personality affect how strongly your child reacts to your leaving. Some ways you can help manage your child's separation protests are to stay calm and positive about your leaving, make the first few times you leave very short, and set a routine you follow each time when you leave. If your child's uneasiness with your leaving doesn't improve after about 15 months of age, talk to your doctor.

See your doctor if your child makes repetitive motions or odd movements or has not bonded well with others, especially caregivers. And watch for signs of hearing problems, such as not reacting to people or loud noises.

Don't hesitate to talk to your doctor anytime you have concerns about your child, even if you're not sure exactly what worries you.

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Promoting Healthy Growth and Development

Talk to your doctor if your child isn't reaching normal growth and development milestones. But keep in mind that every child develops at a different pace. A child who is slow to reach milestones in one area, such as talking, may be ahead in another area, such as walking. Usually it is of more concern when a child reaches developmental milestones but then loses those abilities.

There are things you can do to help promote your child's growth and development.

• Adopt healthy eating strategies.

  Picky eating is common during this age. But a simple and relaxed approach to eating usually helps your child to eat well. Offer healthy foods at regular times. It may also help to set a pattern by being together at the table for all main meals.

• See your doctor for all routine checkups.

  During these visits, the doctor will measure your child's growth to make sure that your child is on track. The doctor will also give your child any needed immunizations.

• Teach healthy habits.

  Teaching healthy habits can help reduce your child's risk of infections.

• Build with blocks.

  Help your child learn to stack blocks and knock them down.

• Scribble on paper.

  You can find washable and thick crayons and pencils that are made for a toddler's fisted grip.

• Play with balls and other moving toys.

  Toddlers love to watch a rolling ball. It helps them learn to track objects. It also improves eye-hand coordination.

• Find toys that your child can turn, sort, pound, push, and pull.

  Examples of toys include knobs, sort-by-shape toys, and thick-paged books.

• Spend time with your child.

  Make an extra effort to sit and play, read, and talk to your child. Don't worry too much about having "play dates" and organized activities for your child between the first and second birthdays. Children this age don't interact much with each other. Rather, they tend to play alone but near each other, a behaviour called "parallel play." Your love and attention are the most important factors that help your child's social and emotional growth.

• Know about your child's individual temperament.

  Every child is different. Getting to know your child's personality helps you to predict and handle their reactions to everyday situations.

• Praise your child.

  When your child reacts well to a difficult situation, such as leaving the park without protest, tell them how proud you are. Your child may not understand the exact meaning of your words. But your child will link the positive behaviour with your approval.

• Don't respond to angry outbursts.

  When you react to a child's temper tantrum or similar behaviour, it is more likely to continue. Unless your child's behaviour is dangerous, ignore it. (But stay nearby and soothe your child as needed.) After the outburst is over, you can talk to your child calmly. Reassure your child that everything is okay. It's very important that you do not get angry or threaten to spank or hurt your child. Staying calm can sometimes be hard. Keep in mind that you are the model for your child's behaviour.

• Provide safe opportunities for exploration.

  Play games that encourage walking and movement, and go outside when you can. For example, help your child walk around the yard with push toys, such as play lawn mowers or bubble poppers. Play chase and race in areas that allow "soft landings."

• Help your child to climb stairs.

  Keep a secure hold on your child as the two of you go up and down stairs together.

• Let your child feel different textures.

  Find items that let your child safely explore the concepts of soft, hard, fuzzy, wet, dry, cold, and warm.

• Talk.

  Get face-to-face and eye-to-eye with your child as much as you can when you interact. Talk in slow and regular speech about the things your toddler can see, what you are doing together, or those things that are an important part of your child's world.

• Respond to your child's words.

  Repeat and expand on what your child says.

• Ask your toddler to use words to express meaning.

  Teach words like "happy," "sad," "angry," "want," "like," and "don't like" so that the child can start to link words with feelings and wants.

• Read to your child every day.

  Also use songs, stories, games, and rhymes to engage your child in language. To help your child's brain develop, play or read together instead of letting your child watch TV, watch movies, or play games on a screen.

Learning parenting skills

Here are some important things to do when you are caring for children.

• Use effective parenting skills.

  Learn and use effective parenting and discipline techniques, and avoid the use of corporal punishment. Parenting classes are offered in most communities. Ask your doctor or call a local hospital for more information.

• Learn healthy techniques to resolve conflicts and manage stress.
• Ask for help when you need it.

  Call a family member or friend to give you a break if you feel overwhelmed. Find out about community resources that can help you with child care or other services you need. Call a doctor or local hospital to find out about a place to start. Some communities have respite care facilities for children. They provide temporary child care during times when you need a break.

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When to Call a Doctor

Call 9-1-1 or other emergency services if you become so frustrated with your child that you are afraid you might cause your child physical harm.

Call your doctor if:

• You are having constant trouble managing your child and often become angry or frustrated. Your doctor can guide you to resources for help if you feel unable to properly care for your child for any reason.
• You are concerned that your child isn't growing adequately or isn't reaching major developmental milestones in any area.

It's also a good idea to call your doctor if your child:

• Shows delays in several developmental areas.
• Successfully reaches a developmental milestone but then loses the new ability.
• Displays behaviours that may be associated with autism. These may include not appearing to interact with or be attached to others, especially caregivers; acting in a repetitive manner, sometimes with odd gestures; or seeming to selectively tune out other people or noises.

When it comes to your child's growth and development, keep the big picture in mind. Each child varies in the exact timing that they achieve milestones. For example, a slight delay in one development area, such as talking, usually is not of concern by itself. As long as your child communicates well through gestures and regularly responds to your speech and that of others, using language usually soon follows.

It's generally of more concern if a child shows signs of a general communication problem, which may include delayed language development. This type of delay can be related to hearing loss. A child with signs of a communication problem does not:

• Know a word other than "mama" and "dada" or can't point to a familiar object when instructed to at 12 months.
• Say a few words, seem to listen when you are talking, or point to what they want at 15 to 18 months.
• Say 5 or more words or understand more than 50 words at 18 months.
• Speak more than 50 words, put two words together, name or try to name objects, or use words to request things at 2 years.

Routine Checkups

During a routine checkup, the doctor examines your child to find out if your child is growing as expected. Your child will get any needed vaccines. And the doctor will ask you questions about the new things your child is doing, such as saying any words or walking. The doctor may also check your child for signs of developmental problems such as autism spectrum disorder (ASD). In some areas, your child may see a public health nurse for routine checkups and immunizations.

In most cases, routine checkups are scheduled several times during ages 12 to 24 months. These visits allow the doctor to keep a close eye on your child's general health and development.

Schedule routine checkups for your child. Talk to the doctor about when to schedule these.

During the checkup, the doctor:

• Measures your child's weight and height and around your child's head. These measurements are plotted on a growth chart to make sure that your child is growing as expected.
• Does a physical examination. In most cases, your doctor looks at your child's eyes and ears, listens to your child's heart and lungs, checks the belly, and looks at the genital area. The doctor may also watch how your child walks and may test your child's reflexes.
• Asks about your child's dental care.
• Reviews your child's vaccine record to make sure it is current. So be sure to bring this record to each visit. In general, your child gets one or more vaccines at routine checkup to age 2. You may want to learn some ways to comfort your child during vaccines.
• Tests your child for anemia.
• Asks questions to see if your child is at risk for tuberculosis or lead poisoning. If there's risk, your child will be tested.
• Talks with your child. The doctor will ask simple questions to test hearing and language abilities. For example, the doctor may ask your child to name or point to a body part.
• Watches how your child interacts with you for clues about your child's emotional and social development. At ages 18 months and 24 months, the doctor may check for signs of ASD.

Routine checkups are a good time to ask any questions or to discuss growth and development issues. Also, talk about your child's new skills, such as walking, using a spoon, or combining words. It may help you to prepare a list of questions to take to your child's checkup.

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